Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

06 April 2019 : Case report  Japan

Aggressive Graphic/Surgical R0 Resection and Jejunal Interposition with Preservation of Mesojejunal Autonomic Nerves in Patients with Stage IV Esophagogastric Junction Adenocarcinoma: A Report of 3 Cases

Unusual clinical course, Unusual setting of medical care, Patient complains / malpractice

Taku Kitano1BDF, Yuki Aisu1BF, Daiki Yasukawa1F, Tomohide Hori1ABCDEF*

DOI: 10.12659/AJCR.913960

Am J Case Rep 2019; 20:465-473

Abstract

BACKGROUND: Three patients with stage IV esophagogastric junction cancer (EGJC) underwent extended resection to achieve a graphic/surgical R0 status (no visible remnant of viable tumor in imaging/surgical findings) and adjuvant chemotherapy from the early postoperative period. We also introduced use of our digestive reconstruction technique in these patients.

CASE REPORT: We used jejunal interposition for digestive reconstruction, which involved end-to-end jejunojejunostomy with a biofragmentable anastomosis ring. The mesojejunal autonomic nerves of the lifted jejunum were preserved. The first adenocarcinoma involved the perilesional lymph nodes (LNs). Graphic/surgical R0 resection was completed by para-aortic LN dissection. The diagnosis (Japanese Classification of Gastric Carcinoma) was stage IV [pM1(LYM)]. Adjuvant chemotherapy began on postoperative day (POD) 11. The second adenocarcinoma was accompanied by a solitary lung metastasis. Intraoperative cytology of ascitic fluid was positive, and cisplatin was intraperitoneally administered. Adjuvant chemotherapy began on POD 10. The solitary lung metastasis was then resected, and graphic/surgical R0 resection was achieved. The diagnosis was stage IV [pM1(PUL) and CY1]. The third adenocarcinoma was accompanied by multiple liver metastases and metastatic regional LNs. The diagnosis was stage IV [H1]. Systemic chemotherapy was repeated. Only a solitary liver metastasis remained and was treated by radiofrequency ablation. Conversion surgery was conducted, achieving graphic/surgical R0 resection. Systemic chemotherapy was continued from POD 10.

CONCLUSIONS: For patients with stage IV EGJC, extended resection to achieve a graphic/surgical R0 status is still controversial, and systemic chemotherapy is important. The results of the present study suggest that our physiological reconstruction technique does not affect the efficacy of other therapies, such as adjuvant chemotherapy.

Keywords: Autonomic Pathways, Chemotherapy, Adjuvant, Drug Therapy, Esophagogastric Junction, Reconstructive Surgical Procedures, Anastomosis, Surgical, Esophageal Neoplasms, Jejunostomy, Lymph Node Excision

Add Comment 0 Comments

In Press

Case report  Mexico

Rare Urinary Tract Infection by Rodentibacter pneumotropicus (formerly, Pasteurella pneumotropica) in an Im...

Am J Case Rep In Press; DOI: 10.12659/AJCR.947344  

Case report  USA

Low Antigen Titre Disseminated Cryptococcosis in Immunocompromised Hosts: Two Challenging Case Reports

Am J Case Rep In Press; DOI: 10.12659/AJCR.946589  

Case report  China

Management of Post-Kyphoplasty Cement Dislodgement in Osteoporotic Vertebral Fracture: A Case Report

Am J Case Rep In Press; DOI: 10.12659/AJCR.947316  

Case report  Japan

Successful Conservative Treatment of Tracheobronchial Injury as a Complication After Emergency Tracheal Int...

Am J Case Rep In Press; DOI: 10.12659/AJCR.947693  

Most Viewed Current Articles

21 Jun 2024 : Case report  China (mainland) 100,250

Intracranial Parasitic Fetus in a Living Infant: A Case Study with Surgical Intervention and Prognosis Anal...

DOI :10.12659/AJCR.944371

Am J Case Rep 2024; 25:e944371

0:00

07 Mar 2024 : Case report  USA 53,680

Neurocysticercosis Presenting as Migraine in the United States

DOI :10.12659/AJCR.943133

Am J Case Rep 2024; 25:e943133

0:00

20 Nov 2023 : Case report  Saudi Arabia 36,071

Azithromycin Treatment for Acne Vulgaris: A Case Report on the Risk of Clostridioides difficile Infection

DOI :10.12659/AJCR.941424

Am J Case Rep 2023; 24:e941424

0:00

07 Jul 2023 : Case report  Saudi Arabia 24,897

A Classical Case of Cesarean Scar Endometriosis in a 35-Year-Old Woman Presenting with Cyclical Abdominal P...

DOI :10.12659/AJCR.940200

Am J Case Rep 2023; 24:e940200

0:00

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923